In her case, she is driven by the desire to protect patients from what she regards as unjust immigration laws that place so-called “illegal aliens” at risk for detention and/or deportation by U.S. authorities.

As she notes, she chooses not to record this data on paper (or in the electronic medical records), even though such data is theoretically private:

While HIPAA typically protects patient health information, it’s not an unconditional legal shield. For these patients, given the current immigration climate, it’s better to be safe than sorry.

Dr. Okwerekwu will discuss relevant aspects of immigration and travel history with her patients verbally — but not in the formal written record.

I’m broadly sympathetic to her approach. My own parents were immigrants to the U.S., and I favor relatively “open” immigration policies. I do support appropriate screening to prevent criminals, terrorists, or carriers of serious contagious disease from entering the country. Such people pose an objective threat to those living here. But otherwise, I welcome any honest, hard-working immigrants seeking to make better lives for themselves in the U.S.

Many patients who own guns are uncomfortable when their doctor asks them about firearms ownership with the intent of recording that data in the patient chart. Gun rights are a very politically charged topic. Although many on the political Left discount gun owners’ fears that the government may some day restrict or outlaw gun ownership, there are many pundits and government officials who routinely praise the strict gun laws in countries like the U.K. and Australia, and repeatedly express a desire to implement similar policies in the U.S.

In both cases — recording immigration status or recording gun ownership — patients fear their personal data may be used against them in the future by an unfriendly government. In both cases, recording such data can undermine a patient’s trust in their doctor. And in both cases, the physician can protect the vital doctor-patient relationship by deliberately not recording that information.

As long as a patient does not pose an objective threat to others, the doctor’s primary responsibility is to the patient’s well-being, in the context of the patient’s individual needs and goals. The contents of the medical record should be between the patient and the doctor — not the government. Doctors should not be unwitting tools of present or future law enforcement.

Patients should feel free to decline to answer any such “social history” questions that make them uncomfortable — and explain why. Conversely, doctors should refrain from asking such questions of patients — or at least pledge to not place that information in the medical record.

(Along the lines of Dr. Okwerekwu’s approach towards immigration, I’m fine with doctors discussing safe storage of firearms and responsible gun ownership as part of oral conversation with patients — but not recording firearm ownership status in the formal written record.)